TY - JOUR
T1 - Pathophysiology and management of opioid-induced constipation
T2 - European expert consensus statement
AU - Farmer, Adam D
AU - Drewes, Asbjørn
AU - Chiarioni, Giuseppe
AU - De Giorgio, Roberto
AU - O’Brien, Tony
AU - Morlion, Bart
AU - Tack, Jan
PY - 2019/2
Y1 - 2019/2
N2 - Background: Opioid-induced bowel dysfunction is a complication of opioid therapy, in which constipation is the most common and problematic symptom. However, it is frequently under-recognised and thus effective management is often not instituted despite a number of treatment options. Objective: The central objective of this study is to provide a summary of the pathophysiology and clinical evaluation of opioid-induced constipation and to provide a pragmatic management algorithm for day-to-day clinical practice. Methods: This summary and the treatment algorithm is based on the opinion of a European expert panel evaluating current evidence in the literature. Results: The pathophysiology of opioid-induced constipation is multi-faceted. The key aspect of managing opioid-induced constipation is early recognition. Specific management includes increasing fluid intake, exercise and standard laxatives as well as addressing exacerbating factors. The Bowel Function Index is a useful way of objectively evaluating severity of opioid-induced constipation and monitoring response. Second-line treatments can be considered in those with recalcitrant symptoms, which include gut-restricted or peripherally acting mu-opioid receptor antagonists. However, a combination of interventions may be needed. Conclusion: Opioid-induced constipation is a common, yet under-recognised and undertreated, complication of opioid therapy. We provide a pragmatic step-wise approach to opioid-induced constipation, which should simplify management for clinicians.
AB - Background: Opioid-induced bowel dysfunction is a complication of opioid therapy, in which constipation is the most common and problematic symptom. However, it is frequently under-recognised and thus effective management is often not instituted despite a number of treatment options. Objective: The central objective of this study is to provide a summary of the pathophysiology and clinical evaluation of opioid-induced constipation and to provide a pragmatic management algorithm for day-to-day clinical practice. Methods: This summary and the treatment algorithm is based on the opinion of a European expert panel evaluating current evidence in the literature. Results: The pathophysiology of opioid-induced constipation is multi-faceted. The key aspect of managing opioid-induced constipation is early recognition. Specific management includes increasing fluid intake, exercise and standard laxatives as well as addressing exacerbating factors. The Bowel Function Index is a useful way of objectively evaluating severity of opioid-induced constipation and monitoring response. Second-line treatments can be considered in those with recalcitrant symptoms, which include gut-restricted or peripherally acting mu-opioid receptor antagonists. However, a combination of interventions may be needed. Conclusion: Opioid-induced constipation is a common, yet under-recognised and undertreated, complication of opioid therapy. We provide a pragmatic step-wise approach to opioid-induced constipation, which should simplify management for clinicians.
KW - Opioid-induced constipation
KW - bowel dysfunction
KW - gastro-intestinal motility
KW - gastroenterology
KW - management algorithm
UR - http://www.scopus.com/inward/record.url?scp=85059298201&partnerID=8YFLogxK
U2 - 10.1177/2050640618818305
DO - 10.1177/2050640618818305
M3 - Review article
C2 - 30788113
SN - 2050-6406
VL - 7
SP - 7
EP - 20
JO - United European Gastroenterology Journal
JF - United European Gastroenterology Journal
IS - 1
ER -